Section G: UArctic Program Student

North2north Student Mobility Program

Application deadlinefor every academic year is February 15.

Section A: Personal Data

Home Country:
Home institution:
Family Name of applicant:
First Name of applicant:
Gender:	 Female  Male
Date of Birth (dd/mm/yy):
Current Address:
Telephone:
E-mail:
Bank Information and SWIFT code:
Permanent address, telephone, email: (if different from above):
Are you a citizen or permanent resident of the country in which you currently reside?  Yes  No
If no what citizenship:
Emergency contact name:
Relationship:
Address:
Telephone:
E-mail:

Section B: Application Information

Do you apply for north2north scholarship	 Yes  No
If not allocated a scholarship, are you still interested	 Yes  No
Do you apply for tuition waiver:[1](Available at most UArctic North-American Institutions and some Icelandic)	 Yes  No

If not allocated a waiver are you still interested?	 Yes  No
If offered are you interested in paying a domestic fee?	 Yes  No

Section C: Academic Information

Your degree program/ major subject:
Year of Study before the exchange:
Intended year of graduation:
Name of north2north contact person at home institution:

Section D: Host Higher Education Institution and Program Preferences

Indicate your desired exchange institution and program preferences and be as exact as possible according to name of courses and eventually course codes. Please rank your first three choices according to preference:

Name of Host Institution:   ………………………………	Program/Courses: ……………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………… ………………………………………………………………
Name of Host Institution:   ………………………………	Program/Courses: ……………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………… ………………………………………………………………
Name of Host Institution:   ………………………………	Program/Courses: ……………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………… ………………………………………………………………

Proposed dates of study:

From (dd/mm/yy):
To (dd/mm/yy):

Section E: Languages

Primary Language:
Other Languages:	Competence, on a scale of 1 to 4 (1 = basic, 4 = fluent)
	 1  2  3  4
	 1  2  3  4
Have you taken an English proficiency test (TOEFL, Cambridge language proficiency, etc.):	 Yes No
If yes, please indicate type and result:	Type: ……………………………… Exam Result: ………………...........

Section F: Indigenous or “Non-traditional” student category

Answering this question is optional.

Are you an indigenous student? (Indigenous people includes first nation people and aboriginals)	 Yes	 No
Do you fit into a “non-traditional” student category? (“Non-traditional” in this context is if you are living in a remote or very small community, are older than the average student, are a student with family obligations etc.)	 Yes	 No
If “Yes” for fitting into a “non-traditional” student category, please describe how:

Section G: UArctic Program Student

Дата добавления: 2015-11-16